Please Read the Instructions Before Continuing

Instructions

Please read the instructions before continuing

v This document is a form. Specific areas within the document can be edited. These areas are known as form fields.

v This form can be completed electronically using Microsoft Word for Windows or Macintosh.

v Form fields are indicated by a . You may type in a form field.

v Use the mouse or Tab button to move from one form field to the next.

v You should save the document locally as required.

v Although in some sections the space available appears limited, use as much space as you need. The section will expand to fit automatically up to the maximum character limit.

v When completed the document should be emailed to the Diabetes Australia Research Program

v Confirmation emails will be sent by return email.

Applications must reach the Diabetes Australia Research Program by closeofbusinessFriday,6 May 2016.

Grant Application 2017

Grant Type

You are applying for (Choose one only of the following options)

General Grant Millennium Award – Type 1 Millennium Award – Type 2

Please answer all questions before moving to the next section

Project Information

Project Title (250 character limit)
Project Aim (Concisely describe the main aim of the project – 500 character limit)
Expected Duration of the Project (Note: General Grants are for a maximum duration of 1 year and Millennium Awards are for a maximum duration of 2 years)
Main Focus (Choose one only of the following options)
Type 1 diabetes / Type 2 diabetes
Gestational diabetes / Pre diabetes
Type of Research (Choose one only of the following options)
Basic science / Clinical research / Translational research
Population (Choose one only of the following options)
Paediatric / Older people
Adolescent/youth / Indigenous
Adult / Culturally and linguistically diverse
Classification (Choose one only of the following options)
Self-management/education / Islet biology
Psychological/behavioural research / Health care systems research
Glycaemic management / Epidemiology
Exercise/nutrition / Insulin resistance/obesity
Complications - Vision/eye health / Complications - Kidney health
Complications - Nerve health
Complications - Cardiovascular health
Complications - Foot disease and wound healing
Complications - Other
Does this project require ethics approval? (Note: successful applications requiring ethics approval will need to provide proof that approval has been granted before any funding will be provided)
Yes / No

Please answer all questions before moving to the next section

Other Grant or Funding Currently Held

Give details of grants or other support currently received by the Responsible Investigator and/or Participants from, or approved by, other bodies for this or related work. Indicate title, granting body, duration and amount of support for each year.
Please answer all questions before moving to the next section

Previous Grants From Diabetes Australia Research

If the Responsible Investigator has received a previous grant from Diabetes Australia Research, please provide details of the outcomes (e.g. publications, other success in obtaining competitive funding) as well as the grant type and year of funding.
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Relationship Of The Study To The Problems Of Human Diabetes

Describe in non-technical terms the significance of the study for human diabetes
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Details Of The Proposed Project

Include:
i) An introductory summary of your previous work in this field, and of the relevant work of others, which leads to the proposed project
ii) Detail the specific aims and potential significance of the project (you may need to use several paragraphs for this section). If hypotheses are to be tested, they should be clearly stated
iii) A research plan, giving details of experimental design and methods to be used
iv) Up to 12 references for General Grants and up to 20 references for Millennium Awards
Please put the details of the proposed project in the blue area below, you may copy and paste any additional information. Use additional pages as necessary, but do not exceed 4pages (excluding references) for General Grants and 9 pages (excluding references) for Millennium Awards. Please tick the checkbox below once you have included the details of the proposed project to complete the section.

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Details of the proposed project included
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Proposed Budget Requested ($)

i) Personnel (indicate base salary and additional leave loading, payroll and other costs as required by employing body) / $
ii) Equipment (Note: applications that include equipment costing over $5,000 will be ineligible) / $
iii) Travel (field expenses etc. Note: applications that include conference travel will be ineligible) / $
iv) Consumables and Other Expenses (itemise these expenses in the Budget Justification section below e.g. animals, printing and stationery, computing, radiochemical, etc.) / $
Total Requested / $

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Budget Justification

Please explain all proposed expenditure. If salaries are sought for specific known personnel, include details of qualifications and experience. Insufficient justification and details will disadvantage the assessment of this application.
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NOTE: The Diabetes Australia Research Program does not fund any administrative or indirect charges by institutions.

Contact For Administration Of Grant

Title / First Name / Surname
Mailing Address
Suburb / State / Postcode
Country
Telephone No. (Work) / Mobile No.
Email Address
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Responsible Investigator

Title / First Name / Surname
Mailing Address
Suburb / State / Postcode
Country
Telephone No. (Work) / Mobile No.
Email Address
Academic and Professional Qualifications
Date of Attainment of PhD if applicable
Current Appointment Held
Administering Institution (Name of institution that will administer the grant/award)
Actual Institution if applicable (If the proposed research will not be undertaken at the above Administering Institution, then please provide the name of the Centre/Institution where the research will actually be conducted)
Average days per month devoted to this project / Average days per month devoted to all other projects

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Publications

Responsible Investigator
Provide a numbered list of articles published in books and refereed journals over the past five years. Indicate with an asterisk (*) the five most relevant articles to the proposed project.
Other
Independent of the above, provide details of 3 articles published in books and/or peer reviewed journals by other authors over the past five years with significant relevance to this project. Please do not provide abstracts, work in preparation or copies of publications.

Area Of Expertise

To facilitate the allocation of applications for review please select one classification from the Type of Research section below and up to three from the Expertise Classification section below that best describes your expertise.
Type of Research (Choose one only of the following options)
Basic science / Clinical research / Translational research
Expertise Classification (Choose up to three of the following options)
Gestational diabetes / Type 1 diabetes
Paediatric / Indigenous
Self-management/education / Islet biology
Psychological/behavioural research / Health care systems research
Glycaemic management / Epidemiology
Exercise/nutrition / Insulin resistance/obesity
Vision/eye health / Kidney health
Nerve health / Cardiovascular health
Foot disease and wound healing
Other (if not listed)

Please answer all questions before moving to the next section

Other Participants

Are there any other participants?
Yes No (Skip this section)
Participant 1
Title / First Name / Surname
Mailing Address
Suburb / State / Postcode
Country
Telephone No. (Work) / Mobile No.
Email Address
Academic and Professional Qualifications
Involvement in days per month

Area Of Expertise

Agreement

I,, of (institution) agree to the terms and conditions as set out in the 2017 Diabetes Australia Research Program Guidelines. I understand that in submitting this application I acknowledge my obligation to participate in the Diabetes Australia Research Program peer review process and I have advised all named Participants of their obligation; specifically, as part of the peer review process, they may be required to review up to three other applications.

Please note agreement to the terms and conditions as set out in the Diabetes Australia Research Program Guidelines is a requirement for your application to be considered.

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